Tuesday, September 23, 2003
Robert Kemp, CEO & Founder, Oaktree Products, Chesterfield, Missouri
From the time we were children, we learned the importance of good oral (mouth) hygiene. Good oral hygiene reduces the risk of gum disease, tooth decay and it reduces bad breath. Good oral hygiene helps you maintain a nice smile and keeps your teeth white, well into your senior years.
However, I'll bet many of you have never heard of good ''aural hygiene,'' or hygiene of the ear. Aural hygiene becomes even more important when one starts wearing hearing aids, earmolds, or using custom made ear inserts such as music delivery systems and generic or custom made ear plugs (to reduce your noise exposure).
Consider this; most hearing aids and all earmolds are worn inside a body cavity, that is, an opening within the body. The ear canal is a warm, moist, dark place where germs love to grow, and they do - even in healthy ears! The ear has quite a sophisticated system for keeping itself clean when it is healthy, but the devices you insert into your ear (hearing aids, earmolds, noise plugs, etc. ) can interfere with the ear's ability to keep itself clean.
You must clean the devices inserted into the ear, or you risk introducing dangerous germs into your ear.
Microorganisms from the ear canal quickly settle on devices placed in the ear. These organisms can grow out of control very quickly on the device, and they are reintroduced to the ear every time the device is reinserted! This may lead to an itchy ear, an odorous (smelly) ear or worse -- an infected ear requiring medical treatment. That's why it is so important to clean and disinfect hearing aids, earmolds and other devices placed in the ear.
What kind of microorganisms are we talking about? Primarily bacteria and fungus but also viruses. A bacterium is a single celled organism that multiplies by simple division. A fungus is a microscopic plant that is capable of growing on dead organic matter or living tissue. A virus is a submicroscopic potentially infectious particle made up of protein and nucleic acids. All microorganisms are capable of causing disease if given the opportunity. Although our immune system plays a critical role in limiting opportunistic infections, we can help by reducing our exposure to germs.
There are a few things to remember about keeping hearing aids (and other devices for the ear) germ free:
First, never submerge a hearing aid in any liquid as it will certainly damage the hearing aid! Rather, use a wipe, so the amount of moisture applied to the unit is controlled. One wipe designed specifically for this purpose is called AudioWipes™ (www.hearingassistant.com). You should avoid using alcohol on all devices inserted into the ear, unless specifically directed to do so by the manufacturer. Alcohol can ruin plastic shells and other delicate components too.
You should always clean the hearing aid (or earmold, earplug, etc.) to remove visible ''gunk'' and then, wipe it with a disinfectant and let it air dry to kill the germs.
At night, store your hearing instrument in a drying kit (also called a dry aid kit) designed specifically to pull moisture out of the hearing aid. Moisture allows germs to grow and can reduce the life of the sophisticated electronics in the hearing aid.
NOTE: Clean the hearing aid off before putting it in the dry aid kit, to keep the dry aid kit clean. Keeping the dry aid kit clean is important because you don't want to place a clean hearing aid in a potentially contaminated or infected dry aid kit.
In my experience, the best hearing aid dryer is the Dry and Store® (www.dryandstore.com, www.hearingassistant.com). The Dry and Store® is a computerized system that utilizes moving, desiccated, heated air to dry the hearing aid inside and out. It uses an effective and efficient ultraviolet lamp to kill germs. The manufacturer reports that those who use the Dry and Store, have more comfortable, longer lasting hearing aids, and they also report batteries last longer.
Be careful about handling hearing aids! When you handle hearing aids, germs from your hands can be transferred to the hearing aid, and germs from the hearing aid can be transferred to your hands. A recent study showed that 100% of all hearing aids were contaminated with moderate to heavy amounts of bacteria and fungus. It is very important to wash your hands carefully before and after handing hearing aids, earmolds and other devices inserted into the ears.
Earwax (the medical term is ''cerumen'') is an important substance for keeping ears clean. This thick sticky substance migrates from inside the ear to outside dragging dirt and germs with it as it goes. Too much earwax can become a problem if it is pushed into the ear and blocks the transmission of sound. This can occur if you use cotton swabs as they potentially push the earwax deeper into the ear. The old adage, ''never stick anything smaller than your elbow in your ear'' really holds true. Over the counter wax softening drops, such as Audiologist's Choice® or Debrox®, can be used to help remove excess ear wax.
Earwax can also be a real problem when it comes to hearing aids as wax often finds its way into the aid - and keeps it from working by blocking the microphone, and/or the receiver. Although there is no absolutely, 100 percent, guaranteed way to keep earwax out of hearing aids and the tiny components, one very good and inexpensive idea is to use a wax guard.
Wax guards come in a variety of forms; there are wax springs, wax troughs, and a unique product called Adhear (www.hearingcomponents.com, www.hearingassistant.com) that can help keep the hearing aid wax free. Adhear are little ''band aid-like'' shields that go over the sound port of the hearing aid and can be disposed of when they get dirty. Your hearing healthcare professional can tell you which one is right for you and your hearing aids!
Perspiration, hairspray, hair gel, other cosmetics and of course dust, can also play havoc with all hearing instruments. It's usually a good idea to apply your make up and cosmetics BEFORE placing the hearing aids in your ears, and then AFTER that's finished, place the hearing aids in the ears.
For Behind-The-Ear (BTE) hearing aids, there are products such as Super Seals www.justbekuz.com that slide over the BTE hearing aids, to keep moisture such as perspiration and rain and snow off of, and out of the hearing aid. A new product called the Hearing Aid Sweat Band is a sort of ''tube sock'' for BTE hearing aids, and it keeps it dry and free from dirt.
For more information about keeping your hearing aids clean and dry, please speak with your hearing healthcare professional.
Wednesday, September 10, 2003
The ear canal is the tube that ends at the eardrum. This is where wax build-up occurs. When the ear canal is exposed to water from baths or swimming, the ear canal which is simply skin, may become infected with bacteria. The canal may appear red and swollen. The main symptom is pain with movement of the ear or touching the ear or pushing on the area in front the ear. This is commonly called an outer ear infection, swimmer's ear or otitis externa
Monday, September 08, 2003
Assistive Devices: Inexpensive and Alternative Ways to Address Hearing Loss
Nancy L. Aarts Ph.D., University of South Alabama
I. Introduction & Overview:
Assistive devices for individuals with hearing impairment fall into two main categories. Assistive Listening Devices (ALD) are products that address problems associated with listening in noise, at a distance, and in high reverberation. Alerting Devices (AD), are products that alert one to the presence of sound in the environment. Assistive devices may be used to improve communication in interpersonal and small and large group settings, on the telephone, while enjoying television programs, or to notify an individual of an important signal in their environment such as the telephone, doorbell, or a safety alarm.
When audiologists and other hearing professionals address the communication needs of people with hearing loss, assistive devices ''fill in the gaps,'' they pick up where traditional ear-level amplification leaves off.
Traditional hearing aids have a relatively small ''effective area'' within which they work maximally, due to microphone size and microphone location. In other words, if two people are engaged in a conversation at a party, and if they move a few feet apart, the distance between the hearing aid microphone and the person speaking can increase dramatically, decreasing the signal-to-noise ratio while introducing significant ambient noise into the conversation. Typically, hearing aids provide acoustic signals only (FM and DAI systems used in tandem with hearing aids do indeed vary from the ''traditional'' limitations and are addressed below), which are subject to reverberation, signal-to-noise issues, background noise and other sources of degradation.
Assistive devices typically pick up signals closer to the sound source, that is, the microphone is placed in close proximity to the sound source. This is accomplished using a variety of methods including various and multiple microphones, induction pick-up systems, and direct connection. Assistive devices can transmit high quality auditory signals across significant distances, such as when an FM or infra-red system is used in a theater or lecture hall. Assistive devices can deliver the signal of interest to the end-user in several ways to assure a high quality sound. Options include various headphones and acoustic couplers, direct audio input or neckloop coupling to a personal hearing aid, vibrotactile signal, or the signal can be visually coded as in captioning.
There are times when assistive devices offer a more appropriate and more efficient solution to communication problems than do hearing aids. Depending on an individual’s communication demands and financial constraints, ear-level amplification may not be the best solution. For example, a telephone amplifier and/or knowledge about how to access closed captioning on a home television set may yield a greater return on investment in a particular situation than would ear level amplification.
Recent studies examined how often audiologists provide information to patients about assistive devices. Prendergast and Kelly (2002) surveyed audiologists to determine the type and amount of audiologic rehabilitation techniques they employed. Results showed that 100% of the 120 respondents reported recognizing the benefit of providing more information about ALDs to their patients, while 78% of the respondents reported they provided information about ALDs to their patients most of the time.
A different perception of how often audiologists provide information about assistive technologies was provided by a survey of consumers. Stika, Ross, and Cuevas (2002) analyzed surveys from 651 members of Self-Help for Hard of Hearing People, Inc (SHHH). The respondents indicated they were hearing aid users who received services from audiologists. Whereas 48% of respondents reported their audiologist made certain they understood their t-switch, only 34% of respondents stated their audiologist informed them about other assistive technologies.
The discrepancy between the survey of audiologists and consumers regarding how often assistive device information is provided could be a matter of perception, recall, or miscommunication. However, it may also serve to alert audiologists and other hearing health care professionals that consumers of our services are not recalling or retaining information about ALDs and ADs, and perhaps we need to transmit the message more consistently, and with greater emphasis.
Despite the benefit of assistive listening devices (ALD) and alerting devices (AD), some audiologists and hearing professionals are not able to provide adequate sample space for assistive technologies ''in-house'' due to cost, space, display, or inventory concerns. Others may not have the same expertise and comfort level with assistive devices as they have with hearing aids, and therefore they may elect to not offer these devices in the office.
II. Inexpensive Options:
A. The Benefits Of T-Coils
There are multiple benefits to flexible, adaptable (larger) hearing aids. T-coils can be built into behind-the-ear (BTE) and in-the-ear (ITE) hearing aids, but very few in-the-canal (ITC) and completely-in-the-canal (CIC) models contain t-coils, a pre-amplifier, and a mic/t-coil switch (Marshall, 2002). Despite the benefits of t-coils, less than 40% of hearing aids sold in the U.S.A. include t-coils (Ross, 2002). This is perhaps due in part to user preference for small, seemingly hard-to-see hearing aids.
My personal experience indicates that more often than not, when faced with the options and alternatives, most people choose t-coils. I generally provide patients with specific advantages and disadvantages of various styles of hearing aids, including a discussion regarding t-coils. Most patients conclude the functional benefits of a BTE or ITE style with a t-coil outweigh the cosmetic advantages of an ITC or CIC style hearing aid.
The key points relating to hearing aid selection, t-coils, and assistive devices, which I address with my patients and their families are noted below.
1-How t-coils and direct audio input (DAI) are used to couple ALDs to hearing aids via neck loops, small area and room loops.
2-How and why a t-coil can improve speech understanding with wired, mobile and cell telephones.
3-How t–coils (and DAI) are generally available in larger hearing aid styles.
4-The availability of ALDs in the community due to the Americans With Disabilities Act (ADA).
5-The benefits of ALDs in situations where hearing aids may not help. For example, in a movie theater or a worship service.
6-I also demonstrate (by wearing) a BTE aid with a clear ear mold in one ear and an ITC in the other ear to demonstrate their appearance when in use.
Providing the above information about t-coils and demonstrating the appearance of different types of hearing aids requires a few minutes of time during the initial discussion, but reduces frustrations and potential remake time later.
B. Order an appropriate t-coil.
An appropriate t-coil must be oriented in the hearing aid in a way that maximizes signal strength. It must be of sufficient strength to provide an audible signal, and lastly, it needs to be activated in a way suitable to the hearing aid user.
Proper orientation is dependent on how the t-coil will be used. The t-coil should be horizontal for telephone use and vertical when a neck or floor loop is used. A diagonal orientation compromises the usefulness of the t-coil in all uses situations. An alternative to diagonal orientation would be to orient the t-coil to the loop and have the user move the receiver to a position that generates the best signal while talking on the phone (Ross, 2002).
The audiologist can specify the orientation when ordering custom products by drawing a line on the earmold impression while it is in the ear to indicate horizontal to the manufacturer. For BTE products, the audiologist should contact the manufacturer to determine each models’ t-coil orientation.
The strength of the t-coil pick-up is dependent on the size of the metal rod around which wire is coiled and on the presence of an amplifier for the t-coil. The larger the rod the more turns of wire, and the more powerful the t-coil (Ross, 2002). The size of the rod may be reduced when a pre-amplifier is available. Some manufacturers offer t-coils that include an integrated amplifier while other manufacturers will require that the audiologist order a pre-amplifier along with the t-coil. Regardless of the way in which the amplifier is added, the audiologist should ensure that an amplifier is included with the t-coil to maximize induction strength.
T-coils can be activated by the common Microphone/Telephone/Off (MTO) switch or a Microphone/Mic+T-coil (M/MT) switch, or, in some BTE models, a switch that offers both M/T/O and M/MT/O options. This type of switch can be difficult to operate for individuals with reduced dexterity. A newer t-coil control option is the ''touchless'' t-coil. This system automatically switches from the microphone to the t-coil when it ''senses'' the magnetic energy of the telephone and switches back to the mic when the magnetic field is no longer apparent (Marshall, 2002). This type of system makes t-coil activation much easier for the hearing aid user, and in particular, for those with limited or reduced dexterity.
C. Confirm the t-coil is working properly.
Real-ear probe-microphone measures (REM) are often used to fit, verify, and adjust hearing aids. The purpose of REM is to ensure the hearing aid output is appropriate. It makes sense to fit, verify and adjust the hearing aid output when the t-coil is active. Additionally, REM can indicate the placement of the telephone near the ear that results in the greatest signal strength and whether or not the volume control wheel (VCW) setting needs to be increased in order to maintain appropriate signal strength in the t-coil mode. See Mueller (1992), and Grimes and Mueller (1991a, 1991b) for specific directions on how to obtain REM with an active t-coil.
D. Teach patients how to use the t-coil.
Adults have reported they received inadequate training on how to use their t-coils when fit with hearing aids (Stika et al., 2002). Education at the time of fitting should include determining the telephone receiver position and VCW setting that produces the greatest signal strength (see above), verification that the patient can manipulate the control switch or remote control, and can recognize when the aid is on ''M'' versus ''T''.
Additionally, if the patient has access to a neck loop or small area or room loop in their home or community (see below), he or she should be reminded that the signal of interest can be accessed just by activating the t-coil and adjusting the VCW if necessary.
The patient should be notified of the availability of a directional array microphone (http://www.etymotic.com/) that can be used with hearing aids that have a t-coil. I also recommend that the patient be given information about the ''Let’s Loop America'' initiative, a public awareness program designed to bring loop systems to more hearing aid users (Myers, 2002).
E. Provide Tips On How To Improve Telephone Communication
Hearing impaired people using wireless phones can often switch from the traditional audible ring option, to the vibrating option. When hearing impaired listeners are having difficulty due to ambient noise levels present while using their phone, they can cover the phone mouthpiece while listening. This simple act reduces the level of background noise picked up by the handset mouthpiece which is also directed to the listener’s ear. Simple and inexpensive ways to increase the intensity of the acoustic signal include a strap-on portable amplifier (for wired, wireless and cellular phones) or an in-line tabletop amplifier (for wired phones) both of which are available from Ameriphone and NFSS. The HATIS cellular phone amplifier (CPA) is available from Life With Ease. Similarly, the telephone’s electromagnetic signal can be amplified with an inductive coupler such as the Oticon TE-80 induction adapter available from Earlink or the Phonear PE 850 available from HARC. Table 1 (below) provides contact information for these and other companies.
F. Encourage Use Of Closed Captioning At Home
If your television has a screen larger than 13 inches and was manufactured after 1993, it will have closed captioning capability. Many people are unaware of closed captioning, its potential benefits, and how to access it. Consider instructing patients in how to access the captioning function via the menu button on their television’s remote control. Some models allow the user to select the size of the captioning text and whether or not the text appears in a box.
G. Educate Patients About The Americans With Disabilities Act (ADA):
The ADA (Public Law 101-336) is landmark civil rights legislation. The ADA went into effect in January 1992 and it provides a comprehensive national mandate for the elimination and prevention of discrimination against individuals with disabilities. Because of the ADA, businesses and employers must take steps to ensure that disabled people, including those with communication disabilities, have access to all goods, services and facilities available to non-disabled people. Additionally, the ADA prohibits discrimination on the basis of disability by private entities and ensures that individuals with disabilities have access to public accommodations, employment opportunities, transportation and telecommunications (U.S. Equal Employment Opportunity Commission, 1992).
All individuals with hearing-impairment, regardless of their age, are affected by the ADA. It is the responsibility of public access facilities, employers, and telecommunication providers to comply with the ADA, but it is the responsibility of the consumer to demand compliance.
However, some consumers -- such as those with hearing loss -- may be unaware of the benefits of the ADA. Therefore, audiologists are the most logical professionals to educate consumers with hearing-impairment about the ADA and the rights of the hearing-impaired. Following are some ways in which audiologists can help their patients learn about and take advantage of the ADA.
1. Display access symbols.
Display the symbol that represents international access for the hearing impaired on your office door, in advertisements, on letterhead, and on mailings. Or, make a flier to instruct patients about this and other relevant symbols about the availability of assistive devices. These symbols are available on the websites www.accessibility.com.au/melbourne/product/signs.htm and http://www.monmouthartscouncil.org/ADA_icons/ADA_icons.html.
2. Provide a list of public access facilities in your community that have assistive devices and encourage ALD use.
Generate a list of theaters and other public venues in your community that are ADA compliant and have assistive devices for the hearing impaired. If time is a concern, you could consider contacting other individuals or organizations and ask them to help you with this task. For instance, you may ask an area SHHH or AG Bell group, or local middle or high school students, who are required to obtain volunteer hours, and suggest they take on this task as a community improvement effort. This list could be put in the form of a flier or brochure that is kept in your lobby, given to patients an initial during appointment, mailed to patients with a monthly bill or used as a column in your quarterly newsletter.
3. Educate Patients About Specific Assistive Listening And Alerting Device Options
There are a number of things that can be done to educate patients about specific devices. First, obtain catalogs from assistive device providers and put the catalogs in your waiting room alongside the magazines (see Table 1). Second, create a notebook of fliers that display photos, descriptions, and purchase information about various devices, and keep this notebook in your waiting room. Third, mail one of these fliers with monthly invoices or post them in your patient care areas. Fourth, develop of list of local providers and distributors in your area who offer reasonable policies for individual purchases, including inventory and price information, and return and repair policies. Fifth, show a looped videotape of assistive devices in your waiting room such as Cindy Compton’s video, ''Doorways to Independence.'' Sixth, for patients who have access to the Internet, compile a list of websites about the ADA and assistive technologies. See Table 2 for a short list of such websites. Make this flier available in the waiting room or put the information in your quarterly newsletter. Seventh, volunteer to give presentations to local SHHH or AG Bell support group meetings, worship groups, senior centers, local professional groups, or adult retirement communities. Presentation topics could include the ADA, local ADA compliance and self-advocacy regarding ADA compliance, t-coil use, the ''Let’s Loop America'' initiative, and demonstrations of specific assistive device technologies.
A Patient's Guide to Tinnitus: 2003 Update
Robert L. Folmer, Ph.D., OHSU Tinnitus Clinic, Oregon Health & Science University, Portland
Tinnitus -- ringing, buzzing or hissing sounds in the ears or head -- is a symptom that can be related to almost every known hearing problem. Tinnitus can be temporary (acute) or permanent (chronic). It can also be constant or intermittent. Temporary tinnitus can be caused by exposure to loud sounds, middle or inner ear infections. Even ear wax on the eardrum can cause tinnitus. Because tinnitus can sometimes be treated medically, all patients who develop tinnitus should first consult with an ear, nose and throat physician (otolaryngologist). Chronic tinnitus is usually associated with some degree of hearing loss. 90% of all patients who come to our Tinnitus Clinic have at least some hearing loss.
Below are common questions asked by tinnitus patients:
Q: Does tinnitus cause hearing loss?
A: No. In fact, the opposite is generally true. Whatever caused the person to have hearing loss (including noise exposure, infections, aging or genetic factors) is probably also responsible for the tinnitus.
Q: Does tinnitus interfere with hearing?
A: No, tinnitus does not typically interfere with hearing. However, tinnitus may affect one’s attention span and concentration. On the other hand, tinnitus might seem louder if hearing loss increases, or if you wear ear plugs or ear muffs, because outside sounds will no longer mask or reduce the perception of tinnitus.
Q: Does cutting the hearing nerve cure tinnitus?
A: Unfortunately, cutting the auditory nerve does not relieve tinnitus often enough to recommend it as a treatment. In fact, cutting the nerve produces total deafness in the operated ear, may cause balance problems, and in some cases may make tinnitus worse.
Q: How many people have chronic tinnitus?
A: According to Seidman & Jacobson,1 approximately 40 million Americans have chronic tinnitus. For 10 million of these people, tinnitus can be a debilitating condition. However, for 30 million Americans with tinnitus, it is not bothersome. Tinnitus does not interfere with the enjoyment of life for the majority of people who experience it.
Q: What can be done to help people who are bothered by chronic tinnitus?
Duckro et al2 wrote: ''As with chronic pain, the treatment of chronic tinnitus is more accurately described in terms of management rather than cure.''
Therefore, the goal of tinnitus management is not necessarily to mask or remove the patient’s physical perception of tinnitus. Successful tinnitus management enables patients to pay less attention to their tinnitus. An effective tinnitus management program helps patients understand and gain control over their tinnitus, rather than allowing tinnitus to control them.
Ultimately, we help most patients progress to the point where tinnitus is no longer a negative factor in their lives. We want patients to move from the ''severely debilitated'' group of tinnitus sufferers, to the ''not bothered by tinnitus'' group and to enjoy their lives as much as possible.
There is usually no cure for chronic tinnitus after it has been present for a year or more. One day, medical science will probably develop a way to eliminate tinnitus. In the meantime, there are several effective management strategies that provide relief for most tinnitus patients.
Elements of an effective tinnitus management program:
It is preferable for the program to have a Tinnitus Management Team, rather than one clinician. Depending on the clinical expertise required to help a particular patient, a Tinnitus Management Team might be composed of an otolaryngologist, an audiologist, a neurologist, a psychologist, a psychiatrist, and sleep or pain specialists.
The Tinnitus Management Team members should be willing and able to spend significant time with each patient.
As much information as possible should be gathered about each patient’s medical, hearing, tinnitus, and psychosocial histories and conditions. Because each tinnitus patient is unique, therapeutic interventions should be individualized. The most successful treatment programs employ multimodal strategies that are designed to address the specific needs of each patient.
Patients should meet with Tinnitus Management Team members for an in-depth interview and review of their histories and conditions. Patients should receive education about possible causes of tinnitus as well as reassurance and counseling regarding factors that could exacerbate or improve their condition.
Thorough otolaryngologic and neurologic examinations.
Comprehensive audiologic evaluations.
Tinnitus evaluation, including matching the pitch and loudness of tinnitus to sounds played through headphones.
Evaluations of acoustic therapies: based on the patient’s audiological evaluations, various devices should be described and demonstrated. These might include hearing aids, in-the-ear sound generators, combination instruments (combinations of hearing aids + sound generators), tabletop sound generation machines, Sound Pillows, tapes or CDs. For patients with hearing loss, hearing aids will not only improve their hearing ability, the devices should also reduce their perception of tinnitus. For patients with normal hearing, in-the-ear sound generators usually provide relief from tinnitus.
The Tinnitus Management Team should review the results of evaluations and explain them to the patient.
Recommendations can then be formulated and explained to the patient. Referral and contact information regarding physical or psychiatric evaluations, psychological counseling, and other recommended services or products should be provided.
Follow-up: patients should be encouraged to contact the clinic anytime if they have questions and also to inform clinicians of their progress
Some tinnitus patients also experience insomnia,3 anxiety4 or depression.5 These symptoms can form a vicious circle and exacerbate each other as illustrated in the diagram below:
Tinnitus is not always the starting point of this cycle. The cycle can begin at any point and progress in any direction. Some patients experienced depression, insomnia, or anxiety before their tinnitus began.
Patients who experience depression, insomnia, or anxiety report that an increase in these factors can cause their tinnitus to seem worse. In these cases, effective treatment of depression, insomnia, and anxiety is necessary. A combination of medication and/or psychotherapy will typically reduce the severity of these symptoms and associated tinnitus.
Are tinnitus management strategies effective?
A long-term follow-up study of tinnitus patients was conducted and published in 2002.6 One hundred ninety patients (133 males, 57 females; mean age 57 years) returned follow-up questionnaires 6 to 36 months (mean = 22 months) after their initial appointment in the OHSU Tinnitus Clinic. Findings of the study were as follows:
This group of patients exhibited significant long-term reductions in self-rated tinnitus loudness, Tinnitus Severity Index scores, tinnitus-related anxiety and prevalence of current depression. Patients who improved their sleep patterns or Beck Depression Inventory scores exhibited greater reductions of tinnitus severity scores than patients who continued to experience insomnia and depression at follow-up.
Identification and treatment of patients experiencing anxiety, insomnia or depression are vital components of an effective tinnitus management program. Utilization of acoustic therapy also contributed to improvements exhibited by patients in this study. Individualized treatment programs that were designed for each patient contributed to the overall improvement in tinnitus severity reported on follow-up questionnaires.
Many clinicians agree that a combination of tinnitus management strategies is more effective than any one form of remediation used in isolation. Even though a customized combination of recommendations is effective for many patients with chronic and bothersome tinnitus, the process can be very time consuming. The time required for patient assessment, education, reassurance, and counseling, as well as for designing and initiating an individualized tinnitus management program, might require four hours during the initial appointment. Follow-up appointments can last two hours or more. Most family physicians and otolaryngologists are not able to spend this much time with one patient during an office visit.
If a clinician has assessed and treated every reasonable medical cause for a patient's tinnitus, and the patient reports little improvement in tinnitus severity, the clinician should refer the patient to a comprehensive tinnitus management program with experienced personnel who are willing and able to spend a substantial amount of time with each patient.
Things to Avoid
1) Harmful Sounds -- Wear ear plugs or ear muffs as protection against loud sounds such as gunfire, gas lawn mowers, leaf blowers, chain saws, circular saws, other power tools and heavy machinery. Exposure to loud sounds can make tinnitus worse and can cause additional hearing loss.
2) Excessive use of alcohol, caffeine, or aspirin -- However, moderate use of these products is usually O.K.
3) False claims about tinnitus ''cures'' or herbal ''remedies.'' These do not exist for most cases of chronic tinnitus.
Even though a true ''cure'' for most cases of chronic tinnitus is not yet available, patients can obtain relief from the symptom now with assistance from qualified and experienced clinicians.
Thursday, September 04, 2003
Richard M.
My name is Richard M. I am a 53 year old who enjoys boating, cross-country skiing and working in my yard.
In November, 2001 after years of nagging, by my wife of 33 years, I swallowed my vanity and went to see Dr. RK in Muskegon, Michigan because of my hearing loss. My idea was that I needed a hearing aid. Thanks to Dr. RK's thorough and comprehensive evaluation, we learned that hearing loss was not the only problem. The diagnosis was an acoustic neuroma, it was about 1 inch in size. Other than a hearing loss in my left ear I had no other symptoms of the tumor.
Dr. RK referred me to Dr. Jack Kartush at the Michigan Ear Institute. A referral for which I am extremely thankful. Dr. Kartush and the staff at the hospital treated me like I was their only patient. They spent all the time I needed discussing my options, the surgery and my recovery concerns.
The ''fear of the unknown'' between the diagnosis in November 2001 and my surgery date, January 17, 2002, was mentally devastating. This was to be my first stay in a hospital. I became extremely depressed and very anti-social.
That all went away the moment I woke up from surgery.
I had my surgery on Thursday, January 17, 2001, it lasted about 7 hours (so they tell me). The first thing I remember is waking up in the ICU to the voice of Dr. Kartush telling me I hit a home run. The tumor was completely removed, cancer free, and I had no facial palsy, I did lose the hearing in my left ear as a result of the surgery, but that was planned ahead of time, and I knew that was going to happen.
Friday morning they removed all the tubes and gadgets and I ate all my breakfast (cream of wheat - not my favorite meal). After breakfast I was able to get out of bed on my own and go to the bathroom unassisted (a move the ICU nurse did not appreciate). My physician was amazed by my quick recovery and progress. I told him I believed recovery from surgery was mostly mental and he somewhat agreed. I had no nausea, dizziness and no significant pain.
Saturday, I walked every hall and stairway I could find on the floor. Although I could not walk in a perfectly straight line I never hit the wall once. My physician visited me and told me that I could go home Saturday morning, if I wanted to, and I did.
After a week at home, I was ready to climb the walls, I was so bored! I was tired of cooking, washing clothes and washing dishes. I needed to be set free. Unfortunately, freedom had to wait a little more. I developed a little infection, which caused some minor facial palsy (weakness). However the infection and the facial palsy went away in about a week, with the help of a couple of prescriptions.
Dr. Kartush suggested that I shouldn't drive a car for a while. My wife agreed and she hid my care keys for three weeks and she wouldn't let me go anywhere alone. I felt like a little kid. After a couple more weeks passed, she allowed me to go to work for a few hours a day, if I could find a ride.
Four weeks after my surgery, my wife and I went to the Boat Show in Miami Florida. I flew on a plane and went out in the ocean on a boat, with no side effects of any kind, except my sea legs weren't as good as I thought they were.
In February 2002, I had my six week check-up and received a clean bill of health. The only restriction remaining from Dr. Kartush, was no bungee jumping. He told me that he would see me in about a year for a follow up.
Its been about 17 months since my surgery and I feel that I have recovered as much as I am going to. I had my 1 year follow-up visit to Dr. Kartush in early June 2003. He & I were both pleased with the results. There is no evidence of any further tumor growth and all systems are functioning properly. Dr. Kartush told me to come back in five years for a final
visit.
The scar has healed and looks like nothing more than another age wrinkle on my neck. The only issue that I have had any difficulty adjusting to is the complete loss of hearing in the left ear. I must concentrate more than before during conversations in open & noisy places, and it seems that I can only listen to one person at a time, this makes my wife mad because it is usually not her that I am listening to!
The surgery has had no affect on my cross-country skiing abilities or lack thereof, when I fall down now, at least I can blame it on something else.
The only thing that I must still be careful at is walking around on our boat. It seems that on the boat I do not have complete control of my balance. This has been only a minor inconvenience, no close-calls or accidents to date. My friends at the Marina keep threatening to tie a line around my waist in case I fall into the water getting on and off the boats.
Today is July 19, 2003. I had my surgery on January 17, 2002. The only side effect of my surgery is acute awareness of the value of modern medicine and respect for very good doctors who take a real interest in their patients needs and concerns.
Debra Hollingsworth
I woke up deaf one morning. It was during the Spring of 1971, I was living in Anchorage, Alaska. No warning, no nothing.
I was a 17 year-old high school student with perfectly normal hearing! I heard fine when I went to sleep. Somehow, during the night -- something happened, something broke or something that was perhaps very tentative or hanging by a thread -- finally broke.
I didn't know I was actually deaf. I went to the ear, nose and throat (ENT) doctor. He said I had ''fluid'' in my ears and he gave me ear drops to take home. He thought that was going to be the end of the matter. Not so!
My hearing was not restored with the ear-drops. The next thing I knew I was on my way to Wilford Hall Medical Center in San Antonio, Texas. My father was a career Air Force man and I was flown from Alaska to Texas on a military medical transport plane.
Two weeks of testing provided no clue as to why I was deaf! It was determined that I had a ''conversion reaction'' or hysterical deafness! They basically could not find a cause, so they determined it was all in my mind!
When I was young, I had many ear infections. Sometimes that's just bad luck, and sometimes it's caused by environmental factors.
I was told that when I was in first grade, I lost my hearing and had surgery to clear out scar tissue and my hearing was restored. In retrospect, I really don't know what was done to my ears at that time. I do know that my parents chain-smoked and I once read an article stating that children of parents who smoked had a higher incidence of ear infections. Then again, ear infections with or without smoking in the house, is the number one reason children go to the doctor!
When we lived in Biloxi, MS, my sister and I and many other neighborhood kids used to follow the mosquito trucks on our bicycles for fun. Basically those were trucks that drove around releasing mosquito repellent in a thick white cloud throughout the neighborhood. All the kids rode their bikes through this cloud of poison for ''fun.'' Who knows how that might have affected my hearing or general health!
Back home again, my family was told I needed to be put in the psych ward. If I refused, my family could lose their medical privileges! So off I went for a six week stay in the mental ward, complete with barred windows and barred doors. I was considered a ''flight risk'' and confined to the floor. Interesting to say the least! I was put on drug therapy and they even tried to hypnotize me. They put me into group therapy. I was newly deafened and did not have good lip reading skills. I learned later that the people in my group had been told to treat me with hostility and to try to make me mad enough to ''forget'' I was deaf. I also went through a week of shock treatment! I demanded to be discharged! They let me go home against their recommendation. I was told to ''come back when you are ready to hear again!''
Four years later, knowing full well I did not have a mental problem, I found a doctor willing to review my medical records to see if there was something else that could be done. There were many things that could be done! He noticed they had never bothered to do an evoked potential test on me. The one test that could prove my hearing loss was ''organic'' was finally done. The actual test was called an auditory brainstem response (ABR) test. The verdict was bilateral nerve damage of idiopathic (unknown) origin.
Yippee!!!!!! I was not crazy. Unfortunately, the diagnosis did ''permanentize'' my hearing loss in my mind. Prior to the ABR, I was sort of clinging to the hope that my hearing would just come back if I tried hard enough. After the ABR, I knew it wouldn't come back. It was gone forever.
By 1985, I was married and we had one daughter. My husband was in the Air Force on a remote assignment in Iceland. I decided to stay in the States and went to Connecticut to stay with my family for a year. In September of that year, my sister read a newspaper article about a man who had received a cochlear implant in a neighboring town. She immediately called the phone number given and before I knew it I was sitting in the office of my new ear doctor.
I was tested and passed with flying colors. My cochlear implant surgery was scheduled! I was implanted with a Storz 4-channel cochlear implant on November 5th, 1985 during a 5-hour surgery. At that time, cochlear implants were still considered experimental and it was a definite leap of faith for me! The operation was a big deal (almost 20 years ago) and it was pretty much standing room only in the operating room that day. My surgery was postponed because one surgeon's flight from San Francisco was delayed and he was assisting! The night before the surgery I was woken up over and over by smiling doctors who asked my permission to attend the surgery.
The first month after hook-up was amazing! After 14 years of silence I could hear environmental sounds--for example, the dishwasher changing cycles and the phone ringing. I could tell the difference between male and female voices, but I was not able to tell what they were saying. I could hear planes overhead and traffic sounds. Music sounded pretty bad--so I didn't really bother with it.
During the second month, I couldn't hear the phone ring anymore and other sounds disappeared. My audiologists tried in vain to keep it going, but one channel after another broke down and by the fifth month I had one channel left and every time I wore my speech processor I got an electric shock! I was told to take it off and not try to use it.
With hope that they might come up with a ''fix,'' I left the internal parts in my head for five years. I finally had the device removed in September, 1990 after a very nasty ear infection in the implanted ear left me at home with visiting nurses coming to the house to hook me up to IV's! I decided to wait until they had ''perfected'' implants a bit more before getting another. I knew that one day I would have another implant. My failed cochlear implant gave me just enough taste of the future that I could wait and when the time was right, I would do it again.
Life went on and I moved to California, divorced and remarried.
In September 2001, I was sent an e-mail from a friend about an entire family who had all received cochlear implants. I did a bit of digging around and found that implants had evolved to the point where speech discrimination was pretty much a given! My wait was over!
This time around I did a lot of research into cochlear implants and found it a fascinating subject! I signed up for CI forums on the Internet and requested materials from all the CI manufacturers. I spent nine months researching them and made my decision about which device I wanted.
After some major insurance hassles, I was soon in the operating room for my second cochlear implant! On June 18, 2002, I was implanted. My daughter and my husband were there with me. One month later, we all met again at the hospital for the big ''hook up'' day. It was a long day, but when I left the hospital I could hear -- amazingly weird hearing, but I knew to expect that at first -- the ducks and chipmunks and freakzoid Darth Vader voices--I was on my way!
As I write this, it has been 6 months since I was hooked-up with my new cochlear implant. Each day is a miracle! I was able to start talking on the phone three weeks after my hook up! At first it was just short conversations, but as time went on, I was able to talk for longer periods, and having 45 minute phone conversations with friends and family members is getting to be commonplace!
I am much more outgoing now and will just walk up and chat with absolutely anyone and everyone. During my deaf years I avoided socializing because it was so stressful. There was a period of time (14 years) when I read an entire book every day, sort of a refuge from the solitary confinement of silence.
Today I listen to music like there is no tomorrow! It sounds very close to the way it used to sound. I have an excellent auditory memory and am very pleased with the way things have turned out!
For my birthday, my daughter and her fiance took me to the Paul McCartney concert at the Anaheim Pond Stadium. That was such a fairytale for me--sort of like going through a ''rags to riches'' story. I had never dreamed I would enjoy a rock concert again! She wanted to make it special--we took a limo and the 10 of us sat right up in front of the stage. I recognized almost all the songs and it was a fantastic teary-eyed event!
Things are getting better and better. My friends and family are constantly commenting on how my voice has changed! I am lucky enough that I was asked to participate in some clinical trials. The manufacturer of my implant is headquartered only a two hour drive away and my friend, who also has a CI, and I were both asked to be part of these trials. This is exciting and wonderful!
Thinking back to that girl I used to be and all that I went through to get to this point seems like a long ordeal. I wouldn't wish it on anyone. Hearing loss is such a traumatic thing to go through. I hope that anyone who might benefit from a cochlear implant will check into it. Life is too short to hang back when you could be listening to MUSIC!
